PSA - 17.1, are Lupron injections necessary?

Not sure what "pc met in L2 and L1" means? can you please explain?

prostate cancer it metastasized first castrate sensitive now resistive

So, with that clinical data, no treatment may be a consideration. PSA is a data point in the decision to treat or not but it is not the prostate cancer and that is what we treat.

GS 6 for the most part is not considered moderate or high risk and may be actively monitored but not treated unless the clinical data indicates a change while monitoring- that could be a subsequent biopsy, preferably not a TRUS but a MRI guided one, imaging results or changes in PSA.

The general rule of thumb for PSADT and PSAV is:
6 months but less than 12 months, treat if other clinical data supports.
> 12 months, continue active surveillance.

Interesting that his PSA is 16.9, when you say has not spread or metastasized, I understand that he has had whole body bone scan imaging and it shows no evidence of PCa anywhere. Since imaging today can detect PCa at levels as low as .2 (my recurrence was located at .7_

At age 79, it may very well be he in the end, he dies not of PCa but of something else. Not trying to be morbid but if his GS is 6 and it could be 8-10 years before there is any metastasis and even then that could be treated, well...

Another question for his medical team may be what are they thinking, a lifetime of ADT or for a definitive period? If the former, fire them. If the latter, define for how long, what is the criteria for stopping, how will they monitor when they do stop, what might the criteria for going back on treatment...

With the clinical data you describe, other than the PSA, none of the clinical data indicates treatment - GS, Imaging, health, PSADT and PSAV. In this case, the "cure," Lupron, is worse than the disease is.

Kevin

Kevin
Given his age and the likelihood of some CV disease, there is an alternative to Lupron, Relugolix which works by blocking the pituitary gland from making hormones that stimulate the testes to make testosterone – thereby lowering a man’s testosterone levels. Instead of an injection, the patient takes an oral tablet once daily, at approximately the same time each day, with or without food. Side effects of ADT can include weight gain, increase in cholesterol levels, and increased risk for heart attack. A striking finding in the clinical trial for this agent was a 54% decrease in major cardiac events (such as heart attack and stroke) in the patients taking relugolix vs leuprolide. It also does not have the flare Lupron does, faster to castration, higher sustained castration and quicker recovery of T after stopping.

I have just finished a 5 session proton treatment for my prostate cancer at Mayo Phoenix and I did not take the Lupron shot that the radiation oncologist wanted to jab me with. I had a PSA of 2.9. I had 5 positive cores out of 30 and the 5 were all from the area on the MRI that showed the lesion. I had 3 cores that were 3-4 and two that were 4-3 that put me in the unfavorable intermediate risk category. I was also a T1c which means that it could not be felt by a DRE only on the MRI. I had only one unfavorable item and that was my 4-3 Gleason score. My PSA was less than 10 and my % of positive cores was way less than 50%. Then there is my age which is 73 and like your grandfather I am fit and active. The article in Radiation Oncology called Radiotherapy with or without androgen deprivation therapy in intermediate risk prostate cancer shows that in men over 70 there was no difference between RT alone and RT+ADT Another article to Google is "The role of proton beam therapy for patients with intermediate and high risk prostate cancer. Age seems to be a factor in the studies I have researched, and I am glad I am over 70. I also had a PSMA Pet scan that showed my cancer was confined to only the prostate. At our age if your grandfather and I get 15 years we are in our 90's. All I know is the side effects for someone of our age is not good and he might not be as active as he is now. It also effects the brain. Read the side effects that the drug causes online. Good luck to you and your grandfather.

1 am 64 and got the 6 month Lupron shot 16 months ago. I still have not got my testosterones back it is 42. The doctor keeps telling to wait 2-3 more months and it should be back. After hearing 3 times I am very upset. My quality of live is horrible. I will never that the Lupron and argued against it. It is true chemical castration. Was not told any of this.

Kchris… I think that for all of the androgen receptor inhibitors, i.e. Erleada, abiraterone, and others, the medium time for OS or cancer Advancement is 40 or so months. I suppose at lot depends on the cancer aggressiveness, one’s overall health and cancer stage when the meds are administered, and the extent of the distant cancer spread, etc. I was on Erleada for a year, post RP. My surgeon gave me a prognosis of 4-5 years, the department head doctor gave me a prognosis of 5-7 years, I think that 5 is the conservative number and I am hoping and planning for more and advancement in new meds. Presently, my cancer is sleeping and I don’t want to wake it!

I had a year of lupron and Erleada and my Gleason score was 9 , no distant metastases. I had manageable and noticeable side effects, but not bad. If the cancer comes back my doctors have advised that they would probably put me back on lupron and Erleada . Hoping for a non occurrence of this SOB. Cancer.

@dimond. I totally agree doctors seem to minimize the effects. When discussing my options she simply said, "Surgery will give you urinary problems in about ten years while radiation will give you bowel problems in the same time." NOTHING was said about Lupron tearing you apart! Just to make it even worse she now tells me the side effects won't improve when I'm finished! On the advice of two doctors not involved with my cancer I decided on surgery but the surgeon advised against it because of my hypertension. The positive is after 18 months/3 injections, my PSA is undetectable so presumably the cancer is under control.
I guess the worst part was being totally unprepared.

I have been on lupron since 21 and aberatron not sure on spelling) plus prednisone I have not had much trouble with it ,if I had to take it for the rest of my life I would,it kept my metatastic cancer in check till new spot on my rib in the back showed up ass aggressive prostate cancer psa was .04 at that time,I was put on chemo it worked had 5 cycles of the strongest chemo plus one it was getting ugly got off it went Xofigo now just had first radiation treatment to that spot if he’s in good health like I was try it you can always stop it good luck